Healthcare Provider Details

I. General information

NPI: 1023284957
Provider Name (Legal Business Name): MARYAM OGHANI SARABI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22639 MULHOLLAND DR
WOODLAND HILLS CA
91364-4940
US

IV. Provider business mailing address

22639 MULHOLLAND DR
WOODLAND HILLS CA
91364-4940
US

V. Phone/Fax

Practice location:
  • Phone: 818-591-5964
  • Fax:
Mailing address:
  • Phone: 818-591-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: